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Psychological interventions for adults with ASD: clinical approaches

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      Abstract

      Purpose – Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based psychological interventions, specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance engagement and outcomes. The paper aims to discuss these issues. Design/methodology/approach – This general review provides a summary of the extant literature and clinical guidelines for the provision of psychological interventions for adults with ASD. Findings – Adaptations to the structure, process, content, and outcome measurement are outlined. It is likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase, pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may arise when seeking to implement change, identify goals, and manage endings. Originality/value – This is one of the first reviews to condense the clinical implications for providing psychological interventions for adults with ASD.

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      Most cited references 21

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      Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders

      Background Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs. Methods Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians. Results Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects. Conclusion ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.
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        Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

         G Bird,  Steve R. Cook (2013)
        It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia—a condition that frequently co-occurs with autism—rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this ‘alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.
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          Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study.

          To systematically examine the patterns of psychiatric comorbidity and functioning in clinically referred adults with autism spectrum disorders (ASD). Psychiatrically referred adults with and without ASD were compared on measures assessing for psychiatric comorbidity and psychosocial functioning. Sixty-three adults with ASD participated in the study (mean age: 29 ± 11 years). Adults with ASD in their lifetime suffered from a higher burden of psychiatric disorders (6 ± 3.4 vs. 3.5 ± 2.7; p < 0.001) including major depressive disorder and multiple anxiety disorders, and were functionally more impaired with a significant proportion having received both counseling and pharmacotherapy. Adults with ASD have high levels of psychiatric comorbidity and dysfunction comparable to a clinically referred population of adults without ASD.
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            Author and article information

            Affiliations
            Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
            MRC SGDP Centre, King's College London, London, UK
            Goldsmiths University, London, UK
            London South Bank University, London, UK And Estia Centre, South London and Maudsley NHS Foundation Trust, London, UK
            Contributors
            Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
            MRC SGDP Centre, King's College London, London, UK
            Goldsmiths University, London, UK
            London South Bank University, London, UK And Estia Centre, South London and Maudsley NHS Foundation Trust, London, UK
            Journal
            AIA
            10.1108/AIA
            Advances in Autism
            Emerald Publishing
            2056-3868
            4 January 2016
            4 January 2016
            : 2
            : 1
            : 24-30
            10.1108/AIA-09-2015-0016
            AIA-09-2015-0016.pdf
            © Emerald Group Publishing Limited
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            General review
            Health & social care
            Learning & intellectual disabilities
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